Ruby Moye Salazar, L.C.S.W., B.C.D. Rubysa2@gmail.com

Clarks Summit, Philadelphia and Narberth, Pennsylvania

PPT is copyrighted and may not be used without permission.

Developmental, Individual-Differences,

Relationship-Based Model

Developed by:

Stanley Greenspan, M.D. & Serena Wieder, Ph.D.

Why is relationship so

important?

• Relationships are the vehicle for

creating learning interactions which

are tailored to child’s individual

processing differences and thereby

enable child to progressively master

functional developmental capacities

Goal of Relationship Based

Approaches

Affect connection and engagement in

common interests between the child,

caregivers and peers

Build relationships which last over

time

Impact neuro-biology

DIRR

: Primary Objective

To enable the child to form a sense of himself as an intentional, interactive and related individual with range of developmental and communicative capacities (cognitive, language, motor, social, emotional..)

WHEN WE INTERACT WITH A CHILD

WE REDEFINE HIS OR HER

POTENTIAL

Assumptions

Every child has his or her own profile of

development and requires an individualized

approach which is developmentally

appropriate

All areas of developmental are inter-related

A child’s symptoms and problem behaviors

often stem from underlying difficulties in

sensory integration and processing, motor

planning and affective integration.

Key Components of a

Relationship Based Approach

Attention/Affect

Engagement

Two Way Communication

Problem Solving

Symbolic Thinking

Abstract Thinking

Key Components integrated into

The Developmental Capacities

(Ladder or Levels)

Level 1:Shared attention and Regulation (begins with affect)

Level 2: Engagement

Level 3: Affective reciprocity and two way communication

Level 4: Pre-symbolic shared social communication and problem solving

Level 5: Symbolic and creative use of ideas

Level 6: Logical and abstract use of ideas and thinking

Affect

What is it?

Outward demonstration of emotion

Child is interested and emotionally

connected

Why is it important?

Emotions drive behavior

Need range of emotions or you are limited in

what you can learn

It is the “glue” that is the basis for all

learning

Affect

What does it look like? Continuous flow of emotion between child

and caregiver

Match with emotion

Need to be able to read the emotion

What do I do? Observe what the child is expressing

Look for opening to respectfully join child in their interests

Once you have the connection, respond based on what child is doing

Engagement

What is it?

After you have affect connection, deepen

the attention with more continuous flow

Takes “attention” to another level

Why is it important?

Necessary for learning and relationship

development

Represents deepening of interests

Stepping stone to more nuanced thinking

Two Way Communication

What is it?

Why is it important?

Two Way Communication

What does it look like?

What do I do?

Problem Solving

What is it?

Have affect connection, are engaged, now

have an idea

• Simple Problem Solving-1 idea

• Complex Problem Solving-more than 1 idea

Why is it important?

If can’t problem solve can’t adapt-life is not

that simple

Need to be able to consider aspects and

variables of our interests

Problem Solving

What does it look like?

“I want to do that”…”I want to go there”…”I want that to happen”

Actions in meaningful sequences

Child is putting together steps

Have goal they are trying to accomplish

What do I do?

Don’t “rescue”

Use playful obstruction

Use every opportunity, makes things a challenge (I.e. don’t open the bag of toys immediately

Give autonomy with complex problem solving

Look at how many steps the child can sequence…what is the best?

Symbolic Thinking

What is it?

Ability to represent a feeling or intent in an

external symbol

Symbols = underlying themes (i.e.

independence)

Why is it important?

Need capacity to have symbols of our ideas

and feelings and with these symbols

generalize and internalize so that every new

situation is not a challenge

Symbolic Thinking

What does it look like?

All earlier levels there (affect, engagement, have ideas), child then expands out to something that logically fits symbolically (give example or show video)

What do I do?

Elaborate, elaborate

Insert obstacles to challenge, to negotiate, be more assertive, find new solutions: be compelling

Use affect cues to hold attention and tolerate dilemma

Deepen plot by posing problems: what, if, then, why, feel, predict

Expand reasoning and incidental learning

Abstract Thinking

What is it?

Person’s ability to consider multiple ideas

and factors ina situation that needs

resolution or clarification

Need to take it all in and get meaning

Why is it important?

If you can’t factor in multiple variables to

come up with insights, won’t be able to

function independently and learn complex

things across environments

Abstract Thinking

What does it look like? Not concerned about the outcome but the

process

Consider many things in making decisions

Child is able to take you and your perspective in as a variable as well

What do I do? Be real

Recognize processing time needs

Add factors they may not have considered, help process multiple factors

The Developmental Levels:

Level 1

Shared attention and regulation

Can put at bay bombarding factors

that take attention away-look at

environment

Can see beginning of attention

Use affect that matches the child

The Developmental Levels:

Level 2

Engagement

Good engagement more than simple

attending

Deeply connect around something in

common with greater intensity

Be fully present and connected

Look at interests and passions and

use them

The Developmental Levels:

Level 3

Affective reciprocity and gestural

communication—purposeful two-way

communication

• Join and interact in a purposeful way

• Reciprocal interaction around an interest

• Child can show you mutuality

The Developmental Levels:

Level 4

Complex pre-symbolic shared social communication and problem solving

Join and interact in a purposeful way around multiple ideas

Err on side of being “under helpful”

Encourage and provide emotional support vs. doing

Play dumb, ask questions and be patient about outcome

The Developmental Levels:

Level 5

Creative use of Ideas and symbols

Use words, pictures, gestures to

symbolically represent an intention

If don’t have verbal language, pay attention

to gestures, subtle cues

Need to value all gestural intentions,

Use PECS, gestures around daily routines

Make sure you have attention, engagement

and affect

The Developmental Levels:

Level 6

Analytical/Logical Thinking and

Abstract use of Ideas

Able to answer why?

Nuanced thinking

Weigh things, consider multiple

factors

Sees forest AND trees

See grays, not just black and white

FloorTime

What is it?

A systematic way of working with a

child to help reach functional

capacities and:

• Learn pleasure of engaging with others

• Gain satisfaction of taking initiative and

making needs known

DIR®/FLOORTIME

It is important because:

It is an intensive intervention

It is a comprehensive intervention

Includes child, family, educators, therapists

Based on recent developmental and neuroscience research

Connects neurons/underdeveloped pathways

Mastery of early emotional interactions

Basic Principles of

FloorTime

Follow the child’s lead

Join in at the child’s developmental level and build on her natural interests

Open, close, and extend circles of communication

Create a developmentally appropriate play environment

Use challenging emotions to expand affective ranges

FloorTime Principles

(continued)

Child must generate the idea ~

• Encourage through use of self, toys,

props

• May rely on favorite ideas, interests, or

even obsessions

• May borrow from books, video, imitating

others—use scripting

• May be a personal concern

Child initiate and invest affectively!

FloorTime Principles:

(continued)

Use playful obstruction, as needed, or play dumb

Expand, expand, expand ~ keep going, make

mistakes, follow orders, interfere, beg forgiveness!

Change expectations to create surprise and

novelty

Don’t take no for an answer ~ objecting, rejecting

and undoing is a response!

INSIST on a response ~ child must close circle

Be compelling but not too stressful—MATCH!

FloorTime Principles

(continued)

New meanings

All activities should be meaningful to the child

Give the child the problem to solve ~ but it must be a

“problem for him or her!”

Interact constructively to help child do what

they want to do and do not change the

topic!

Treat whatever child is doing as intentional

and purposeful ~ Give old behavior

FloorTime

Principles

Join children in pleasurable ways but do not back away from anger

Difficult feelings are a part of life

Opportunities for interaction and communication are created

Always re-establish shared attention, engagement and circles of communication

Always re-establish a continuous flow of back and forth affective gesturing at all times both during the foundation building levels and symbolic play

FloorTime Challenges

Related to Parent’s or Adult’s

Approach

To follow lead and not take over or direct

DO NOT be seduced into teaching mode

To stay on child’s topic and not distract

To know what to do next!

To respect child’s body: maintain

regulation!

To use enough affect cues

FloorTime Common Mistakes

Does not maintain a continuous flow of interaction

Does not shift levels in order to stay engaged

Follows child “commenting” without or little communication

Does not provide sufficient affect cues and gestures

Teaches instead of interacts

Coaching Each Other or

Yourself

Did you observe long enough – allow child

time to warm up, adapt to new situation?

Did you check or ask if interaction you are

observing is typical or not?

Who is initiating? Who is in the lead? Who

is following?

Who is opening the circle? Who closes it?

How may circles are being opened or

closed?

Coaching Each Other or

Yourself (continued)

What are the primary challenges to the interaction?

For example:

Child ~ Aimless? Avoidant? Disengaged? Poor communication-gestures, verbal? Poor motor planning or execution of intentions? Passive? Low tone? Hyper-reactive? Hypersensitive? Hypo-reactive? Poor symbolic? Fragmented? Anxious?

Adult ~ Takes over the lead? Changes topics? Controls child’s body? Over-relies on sensory motor activities? Misses cues? Lacks affect? Poor timing? Concrete? Works below level? Works above child’s level? Anxious? Depresses?

What else can you do?

Thank you!!!

I especially want to thank the

children and their families

from who I continually learn.